On The Need for More Research on Ageing Sexuality in the History of Medicine
Alison M. Moore*
Senior Lecturer In Modern European History, Australia
Submission: June 01, 2018; Published: June 06, 2018
*Corresponding author: Alison M. Moore, Senior Lecturer In Modern European History, Australia.
How to cite this article: Alison M. Moore.On The Need for More Research on Ageing Sexuality in the History of Medicine. OAJ Gerontol & Geriatric Med. 2018; 4(3): 555639. DOI: 10.19080/OAJGGM.2018.04.555639
Between 1774-1940, over 100 different European doctors authored works on sexual ageing, defined either as menopause, andropause, or referring to the non-sex-specific term the ‘critical age’. Ideas about these related concepts were elaborated either as complete books, medical theses or as chapters within larger works on hygiene, longevity, menstruation, women’s health or hysteria, including works by major figures such as English physician and Quaker John Fothergill , the French physicians [2,3], Alexandre Brierre de Boismont , and Sébastien Guyétant  the infamous Parisian hysteria neurologist and teacher of Sigmund Freud [6-10]; the renowned French interwar surgeon and the renowned Spanish endocrinologist Gregorio Marañon. Throughout the nineteenth century, French doctoral theses frequently featured the specialist topics of menopause or the ‘critical age’, and over 50 medical theses on these topics remain available to researchers only in fragile hard-copy form in the French national library.
This massive elaboration of ideas about sexual ageing in the nineteenth century has most likely been overlooked in the historiography of sexuality because it occurred less within psychiatry, psychoanalysis and sexology, as was the case for most other major ideas about sexuality, but rather in texts of ‘hygiene’, or in the emergent specialisations of gynaecology and later endocrinology. It should be noted that neither Freud nor Havelock Ellis nor most of the other canonic figures of sexological and psychoanalytic thought contributed significantly to discussions of sexual ageing.
Histories of old age in general have become an important field of historical research, though most mention sexuality either not at all [11-13], or only briefly [15-17]. Other humanistic studies that have considered images of sexual older adults have tended to focus on women only and are most concentrated on early-modern European fictional and theatrical representation [18-20].
The term ‘menopause’ was a French invention and throughout the nineteenth century, medical research on sexual ageing was heavily dominated by French doctors, only disseminating gradually to other parts of Western Europe and to the US over the second half the nineteenth century, and only becoming a major topic of international medical inquiry in the early twentieth century. After this, France remained a major contributor to medical ideas on sexual ageing until the Second Wold War, after which it was eclipsed by the burgeoning of sex-steroid-hormone research in the US and elsewhere.
Specialist scholarship on the nineteenth-century French history of menopause and the ‘critical age’ has been patchy and sporadic [21-26], with a thorough inquiry remainng to be done. Major scholarly studies of the history of menopause have been broad cultural histories not sufficiently focused on medical sources, including Judith Houck’s, Hot and Bothered , which is entirely about twentieth century America, and Louise Foxcroft’s Hot Flushes, Cold Science  which skims European, British and American sources selectively from the early modern period to the early twenty-first century, with its main focus on twentieth century Britain and the US, considering only women’s menopause. Elizabeth Siegel Watkins, The Estrogen Elixir focuses on the twentieth-century history of American hormone replacement for menopausal women only, without consideration of the extent to which these therapies targeted sexual libido. No major histories of menopause have examined comprehensively the most significant source corpus in the development of medical ideas about it, which were produced in France throughout the nineteenth century, though several studies have referred selectively to texts within this corpus. None of these studies consider menopause in the context of ideas about sexual ageing in both men and women. All major historical studies of women’s menopause assume a definition of it that reflects contemporary notions of its symptomology (hot flushes, disordered sleep, weight gain and mood dysregulation), rather than attending closely to the unique symptomology of past ideas about it which emphasised perverse sexuality, hyper-sexuality, non-conformist social behaviour, as well as oedema and uterine haemorrhages .
Overwhelmingly the scholarship on the history of menopause has tended to view the concept in isolation from other ideas about sexual ageing which were in fact even more dominant. This has produced a distortion in the historiography, promoting a view of menopause as indicating a modern rupture, whereby medicine is thought to have suddenly begun representing the sexes asymmetrically from the end of the eighteenth century. This is what the famous Berkeley historian Thomas Laqueur referred to as the shift from a ‘one-sex’ mirror-view of the sexes toward a ‘two-sex’ model of radical difference [29-31]. This author has already written critically about the historiographic tendency to overlook the persistence of homologous views of the sexes in the history of medicine [32-37]. As a result of this tendency, none of the previous studies of menopause in history have considered the substantial body of sources discussing men’s menopause. Many highly respected French medical scholars in the nineteenth, and indeed well into the twentieth century, continually preferred non-sex-specific terms, such as the ‘critical age’, over menopause precisely because they allowed men to be included in the elaboration of the condition. Eventually, even the female-specific term ‘menopause’ was coopted into the description of men’s critical age, with references to ‘male menopause’ or ‘andropause’ appearing in twentiethcentury ideas. Menopause then, up until the Second World War, only partially succeeded in differentiating women’s ageing from men’s.
In the second half of the twentieth century, new medical and sociological understandings of sexual ageing emerged. From this time, a novel set of arguments about sexuality and ageing appeared across both social science and biomedical disciplines which differed markedly from past medical views. Some, such as the urologists J Berman and J Bassuk claimed that female sexual dysfunction was an “age related, progressive and highly prevalent” phenomenon . On the other hand, some sociology scholars since the 1970s have argued that the very assumption of sexual decline in ageing is a form of oppressive traditionalist thought that denies the aged the right to pleasure [39-42]; and the editors of a recent collection of essays about ageing and sexuality refer to “moving beyond the stereotype of older people as asexual [43,44].” Current geriatric nursing researchers working on these questions commonly refer to a “pervasive ageism” that inflects assumptions about ageing and sexuality.
Some of this divergence of contemporary views might be attributable to ongoing shifts in the sexual behaviour and expectations of older adults. A 2013 Swedish study indicated an increase in sexual activity among 70-year-old men and women surveyed in the years 2000-1 relative to those surveyed in 1971-1972 [45-47]; and a US study of 2015 indicated that 60% of women over age 60 in committed romantic relationships report regular sexual activity, while 13% of those not in such relationships also report regular sexual activity . As the authors of several Finnish sociology studies on ageing and sexuality note, “the generations subsequent to the era of sexual revolution of the 1960s and 1970s have considerably modified their sexual values and behaviour patterns,” resulting in a higher prevalence of sexual interest and activity in old age . The evidence of sexual desire declining with ageing then appears to correspond to developments in twentieth-century history after the Second World War, and to have important moral and cultural dimensions.
In our own time, positive claims about elderly sexuality may need to be considered in relation to commercial interests and the politics of globalization. Biological historians such as Nelly Oudshoorn have shown that the pharmaceutical commercialisation of sex steroid hormones (especially the contraceptive pill) has had a profound influence on ideas about female sexuality and sexual difference . The spectacular multinational proliferation of Hormone Replacement Therapies (HRT) at the turn of the twenty-first century, particularly aimed at post-menopausal women, but also increasingly testosterone replacement therapy aimed at ageing men, warrants a similar inquiry. It is worth considering whether pharmaceutical research into both HRT and Viagra may be a driver of recent affirmations of the inevitable physiological decline of libido produced in ageing bodies. Much of the scientific research on ageing and sexual desire since the nineteen-seventies has been supported by pharmaceutical companies looking to develop drug-remedies for both male impotence and for the DSM category of Female Sexual Interest/Arousal Disorder , both which are shown in this body of scientific research to be correlated with ageing.
Specific cultural expectations about the normalcy of elderly sexual desire can have a great impact on how individuals experience themselves as sexual subjects in old age. It also clearly impacts how clinicians treat older adults, as the work of several sociologists demonstrates, with many doctors avoiding discussion of sexually-transmitted disease risk with older patients, erroneously believing it to be irrelevant to them. Some studies have suggested that sexually-transmitted diseases may be increasing among older adults [52,53]. It therefore seems beneficial to generate greater cultural awareness of the capacity of older adults to be sexually active, and to de-stigmatise this so that it is not a source of shame or denial.
On the other hand, several researchers have suggested that the increasing celebration of older adults’ sexual needs may itself be a product of commercial interest, benefiting companies marketing products for older people [54,55]. While researchers have typically thought of this in relation to health-targeted products such as supplements and fitness programs, it is clear also that sexuality is one such ‘need’ that may be emphasised to older adults in the effort to generate feelings of lack that may drive them toward the purchase of sexual devices, services or purported pharmaceutical aids. Importantly, the very notion of age-related sexual decline appears to have emerged in twentiethcentury science along with the emergence of hormonal and other pharmacological agents aimed at stimulating libido. In this context, a rigorous historical study revealing how our current concepts of sexual aging came about would be a helpful stimulus for older adults themselves, as well as clinicians, researchers, aged-care workers and the general reading public to toward a stronger sense of older adults’ potential needs but also of the pressures acting upon these.
- Fothergill John (1774) Of the Management Proper at the Cessation of the Menses. In The Works of John Fothergill. John Coakely Lettsom (London: Charles Dilly), UK, pp. 201-220.
- Menville, Charles (1839) Conseils aux femmes à l’Époque de l’âge de retour, ou de l’âge critique, et de moyens de combattre et prévenir les maladies qui peuvent survenir à cette époque de la vie (Paris: Germer Baillière).
- Marshall, Barbara L, Stephen Katz (2002) Forever Functional: Sexual fitness and the ageing male body. Body and Society 8(4): 43-70.
- Brierre de Boismont, Alexandre (1842) De la menstruation considérée dans ses rapports physiologiques et pathologiques (Paris: G. Baillière).
- Guyétant, Sébastien (1870) L’Âge de retour et la vieillesse; conseils aux gens du monde (Paris: P. Brunet).
- Brown W (2003) Promoting Healthy Ageing in Australia. Report of the Prime Minister’s Science, Engineering and Innovation Council Independent Working Group. Canberra: Department of Education, Science and Training.
- Charcot, Jean-Martin (1874) Leçons cliniques sur les maladies des vieillards et les maladies chroniques (Paris: Delahaye).
- Cryle, Peter, Moore, Alison (2011) Frigidity, an Intellectual History. Basingstoke: Palgrave.
- Fileborn B, Thorpe R, Hawkes G, Minichiello, V (2015) Sex, Desire and Pleasure: Considering the experiences of older Australian women. Sexual and Relationship Therapy 30(1): 117-30.
- Gippsland Priority Health Needs, ‘Sexuality and Ageing’.
- Goodfellow, Sarah (2004) ‘The Sexual Hush’: Representations of latelife sexuality in western Europe and America, 1870-1930. Pennsylvania State University, College of Liberal Arts.
- Thane Pat (2000) Old Age in English History. Oxford: Oxford University Press, USA.
- Minois, George (1989) History of Old Age: From Antiquity to the Renaissance. Cambridge: Polity, USA, pp. 343.
- Moore Alison (2015) Sexual Myths of Modernity: Sadism, masochism and historical teleology. Lanham: Lexington.
- Troyansky, David (1989) Old age in the old regime: image and experience in eighteenth-century. France (New York: Cornell University Press), USA.
- Wallace, Meredith (2011) Nursing Standard of Practice Protocol: Sexuality in the older adult. In Marie Boltz, Elizabeth Capezuti, Evidence-Based Geriatric Nursing Protocols for Best Practice, (4th edn.); Springer Publishing LLC, 2011.
- Watkins, Elizabeth Siegel (2009) The Estrogen Elixir: A history of hormone replacement therapy in America. Baltimore: Johns Hopkins University Press, USA.
- Taunton, Nina (2007) Fictions of Old Age in Early modern literature and culture. New York: Routledge, USA.
- Taylor, Abi, Gosney, Margot A (2011) Sexuality in Older Age: Essential considerations for healthcare professionals. Age and Ageing 40(5): 538-543.
- Kittredge, Katherine (2002) ‘The Ag’d Dame to Venery Inclin’d’: Images of sexual older women in eighteenth-century Britain. In Susannah R Otttoway, LA Botelho, Katherine Kitteredge (Eds.); Power and Poverty: Old age in the pre-industrial past. Westport: Greenwood Press, pp. 247-263.
- Théré, Christine (2015) Âge de retour et retour d’âge: L’assymétrie entre les sexes dans les discours médicaux en France (1770-1836). Clio Femmes, Genre, Histoire 42: 53-75.
- Thorpe R, Fileborn B, Hawkes G, Pitts M, Minichiello V (2015) Old and Desirable: Older women’s accounts of ageing bodies in intimate relationships. Sexual and Relationship Therapy 30(1): 156-66.
- Tillier, Annick (2005) Un âge critique. La ménopause sous le regard des médecins des XVIIIe et XIXe siècles. Clio Histoire, femmes et sociétés 21: 1-10.
- Toulalan, Sarah (2016) ‘Eldery Years Cause a Total Dispaire of Conception’: Old age, sex, and infertility in early modern England. Social History of Medicine 29(2): 333-359.
- Wilbush, Joel (1979) La Ménespausie-The Birth of a Syndrome. Maturitas 1(3): 145-151.
- Zhu, Weimo, Owen, Neville (2017) Sedentary Behaviour and Health: Concepts, Assessments and Interventions. Champagne IL: Human Kinetics.
- Houck, Judith (2006) Hot and Bothered: Women, Medicine and Menopause in Modern America. Cambridge MA: Harvard University Press, USA.
- Foxcroft, Louise (2010) Hot Flushes, Cold Science: A History of the Modern Menopause. London: Granta.
- Laqueur, Thomas W (1990) Making Sex from the Greeks to Freud (Cambridge MA: Harvard University Press), USA.
- Malta, Sue (2014) Invisible Sexuality: Older adults missing in sexual health research. The Conversation.
- Marañon, Gregorio (1932) The Evolution of Sex and Intersexual Conditions Trans. Warren Bradley Wells, London: Allen & Unwin, UK.
- Moore, Alison M (2018) Conceptual Layers in the Nineteenth-Century French Invention of Menopause. French History 32(2): 226-248.
- Moore, Alison M (2018) Victorian Medicine Was Not Responsible for Repressing the Clitoris: Rethinking Homology in the Long History of Women’s Genital Anatomy. Signs: The Journal of Women in Culture and Society.
- Müller, Jan-Werner (2014) On Conceptual History. In Darrin M McMahon, Samuel Moyn (Eds.); Rethinking Modern European Intellectual History (New York: Oxford University Press), USA, pp. 74- 92.
- Arnaud Sabine (2015) On Hysteria: The Invention of a Medical Category Between 1670 and 1820. Chicago: University of Chicago Press, USA.
- Australian Bureau of Statistics.
- Barrett ES, Parlett LE, Wand C, Drobnis EZ, Redmon JB, et al. (2014) Environmental exposure to di-2-ethylhexyl phthalate is associated with low interest in sexual activity in premenopausal women. Hormones and Behaviour 66(5): 787-792.
- Berman JR, Bassuk J (2002) Physiology and Pathophysiology of female sexual dysfunction. World Journal of Urology 20(2): 111-118.
- Kosellek, Reinhart (2002) The Practice of Conceptual History: Timing History, Spacing Concepts. Stanford: Stanford University Press, USA.
- Kuhn, Margaret (1976) Sexual myths surrounding the ageing. In Wilbur W Oaks, Gerald A Melchiode, Ilda Filcher (Eds.); Sex and the Life Cycle (New York: Grune and Stratton), USA, pp. 117-124.
- Jordheim, Helge (2012) Against Periodization: Kosellek’s theory of multiple temporalities. History & Theory 51(2): 151-171.
- Kelly James J, Rice Susan (1986) The Aged. In GL Gochros, JS Gochros, J Fischer, Helping the Sexually Oppressed (New Jersey: Prentice Hall, 1986), USA, pp. 98-116.
- Pauchet, Victor (1932) L’Automne de la vie; l’homme et la femme à l’âge critique (Paris: Editions J Oliven).
- Peel, Elizabeth, Harding, Rosie (2017) Ageing and Sexualities: Interdisciplinary Perspectives. London: Routledge, UK.
- Pernau, Margrit, Dominic Sachsenmaier (2016) Global Conceptual History, A Reader (London: Bloomsbury, 2016), UK.
- Rees, Margaret, Lambrinoudaki, Irene (2018) Joint Opinion Paper- ‘Aging and sexual health’ by the European Board & College of Obstetrics and Gynaecology (EBCOG) and the European Menopause and Andropause Society (EMAS). European Journal of Obstetrics & Gynaecology and Reproductive Biology 220: 132-134.
- Siegel Watkins, Elizabeth (2009) The Estrogen Elixir: A history of hormone replacement therapy in America. Baltimore: Johns Hopkins University Press, USA.
- Thomas HN, R Hess, RC Thurston (2015) Correlates of sexual activity and satisfaction in midlife and in older women. Annals of Family Medicine 13: 336-342.
- Kontula, Osmo, Haavio-Mannila, Elina (2009) The Impact of Ageing on Human Sexual Activity and Sexual Desire. Journal of Sex Research 46(1): 46-56.
- Oudshoorn, Nelly (1998) Beyond the Natural Body: An archaeology of sex hormones. Abingdon: Routledge.
- American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association.
- Johnson BK (2013) Sexually Transmitted Infections and Older Adults. Journal of Gerontological Nursing 39(1): 53-60.
- Gott, Merryn (2005) Sexuality, Sexual Health and Ageing. New York: Open University Press, USA.
- Groneman, Carol (2001) Nymphomania, A History. New York: W.W. Norton & Co, USA.
- Minkler, Meredith (1989) Gold in Gray: Reflections on business’ discovery of the elderly market. The Gerontologist 29(1): 17-23.